In November 1995, video-assisted minimally invasive direct coronary artery
bypass procedure, which is defined as a combination of the thoracoscopic in
ternal mammary artery (IMA) harvest and direct coronary bypass grafting, wa
s introduced for patients who need minimally invasive direct coronary arter
y bypass (MIDCAB) using IMA. In the thoracoscopic IMA harvest, the pleural
adhesions or symphysis present an obstacle. We present a case where a redo
patient who had complete pleural symphysis of left chest cavity precluded t
he thoracoscopic IMA harvest, and MIDCAB with the H graft procedure was per
formed. (C) 1999 by The Society of Thoracic Surgeons.